Introduction: Establishment of a formal intestinal rehabilitation service is associated with improved outcomes for intestinal failure (IF) patients. We compared incidence, aetiology and outcomes of inpatients with IF at the only tertiary children’s hospital in New Zealand, before and after the establishment of the New Zealand National intestinal Failure Service (NZ NIFS).

Method: A retrospective review of intravenous nutrition (IVN) records identified patients with IF aged 0–18 years, admitted to Starship Child Health between July 2010 and October 2018. IF was defined as inpatients receiving IVN ≥21 days as per the NZ NIFS criteria.

Medical records were reviewed to identify demographics, indication for IVN, biochemical markers for intestinal failure-associated liver disease (IFALD) and clinical outcome. Indication for IVN was defined as per NZ NIFS pathological classifications (adapted from 2016 ESPEN guidelines for chronic IF in adults): extensive small bowel mucosal disease; mechanical obstruction; intestinal dysmotility; intestinal fistula; short bowel syndrome and other diagnosis. IFALD was defined as peak bilirubin >34mmol/L, for at least 2 weeks, in the absence of another cause.

Results: 882 children received IVN during the 8 year period. 19% (171/882) were classified as having IF. The IF patients came from 17 of NZ’s 20 health care districts. There was no significant increase in patient transfers between the time periods. Three quarters of IF patients came from three of 11 referring teams; oncology 33% (51/171), gastroenterology 28% (48/171) and ICU 19% (32/171).

Common indications for IVN were extensive small bowel mucosal disease (46%), short bowel syndrome (15%) and mechanical obstruction (13%).

IFALD occurred in 9% (15/171), there was no difference between the time periods. There was a slight excess of patients with mechanical obstruction (17%, 4/23) but this was not statistically significant.

73% (125/171) had successful intestinal rehabilitation to enteral autonomy. 6% (10/171) were established on home IVN and existing home IVN patients accounted for 9% (15/171) of IF admissions. Intestinal transplantation was necessary for only one patient. No mortality related to IFALD was identified, however 12% (20/171) died from their underlying diagnosis.

Conclusion: Since the establishment of NZ NIFS in 2015 our inpatient IF demographics have remained broadly the same, the incidence of IFALD remains low and inpatient numbers have not increased.